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Patient Forms

If you would like to print and fill out the forms below, please arrive 5 minutes before your appointment.
Otherwise, please arrive 15-20 minutes before your appointment to fill out the paperwork at our office.

Insurance Accepted

We accept several major dental insurances. If we have received all of your insurance information prior
to the day of your appointment, we will be happy to submit a claim on your behalf. Please be familiar
with your plan and be prepared for any amount that may not be covered, such as a co-pay. Please
contact your insurance or contact us prior to your first appointment to ensure you have coverage with
our office. Please keep us informed if any insurance changes occur.

Request Appointment

Cancellation Policy

It is the patient’s responsibility to keep scheduled appointments. Our practice requires notification of cancellation at least 24 hours prior to the appointment or earlier if possible. Our practice will consider an appointment a No Show any time a patient has not given 24 hours advance notice of cancellation or has failed to arrive within 15 minutes of their appointment time. Patients who No Show for 2 appointments in a 1-year period will be dismissed from the practice. Patients may also be subject to a $65.00 missed appointment fee. The Cancellation and No Show fees are the sole responsibility of the patient and must be paid in full before the patient’s next appointment. We understand that Special unavoidable circumstances may cause you to cancel within 24 hours. Fees in this instance may be waived but only with management approval. Our practice firmly believes that good physician/patient relationship is based upon understanding and good communication.